Download PDF
Viszeralchirurgie 2006; 41(5): 306-312
DOI: 10.1055/s-2006-942223
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Stellenwert der lokalen Exzision von Rektumkarzinomen

The Significance of Local Excision for Rectal CarcinomasT. Borschitz1 , T. Junginger1
  • 1Klinik und Poliklinik für Allgemein- und Abdominalchirurgie der Johannes-Gutenberg-Universität Mainz
Further Information

Publication History

Publication Date:
27 October 2006 (online)

    Permissions and Reprints

Zusammenfassung

Die lokale Exzision von frühen Rektumkarzinomen stellt eine etablierte, onkologisch adäquate Therapie dar. Dennoch weisen die Lokalrezidivraten eine hohe Spannbreite auf und es bestehen unterschiedliche Therapiekonzepte. Unklar ist in diesem Zusammenhang die Indikation zur lokalen Exzision von Rektumkarzinomen, d. h. ob neben T1-„low-risk”-Karzinomen auch weiter fortgeschrittenere Tumoren (T2) lokalchirurgisch behandelt werden können. Ziel dieser Arbeit ist, die Lokalrezidivraten zu analysieren und die Bedeutung einer multimodalen Therapie aufzuzeigen.

Abstract

Local excision of early rectal cancer represents an established oncologically adequate therapy. However, local recurrence rates show a large variability und different therapeutic concepts exist. In this context, the indication for local excision of rectal cancer is unclear, e. g. whether in addition to “low-risk” Th1 carcinomas more advanced tumors (T2) can also be treated with local surgery. The aim of this review was to analyze local recurrence rates and to highlight the relevance of multimodal therapy.

Schlüsselwörter

Rektumkarzinom - lokale Exzision - frühe Nachoperation vs. Rezidivoperation - adjuvante vs. neoadjuvante Radiochemotherapie

Key words

rectal cancer - local excisison - immediate vs. salvage reoperatrion - adjuvant vs. neoadjuvant chemoradiation

Literatur

  • 1 Borschitz T, Heintz A, Junginger T. The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: Results of local excision (transanal endoscopic microsurgery) and immediate reoperation.  Dis Colon Rectum. 2006;  , [Epub ahead of print]
    PubMedGoogle Scholar
  • 2 Borschitz T, Junginger T. Value of local surgical therapy of rectal cancer. A literature analysis.  Zentralbl Chir. 2003;  128 1066-1074
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Duek S D, Krausz M M, Hershko D D. Transanal endoscopic microsurgery for rectal cancer.  Isr Med Assoc J. 2005;  7 435-438
    PubMedGoogle Scholar
  • 4 Faivre J, Chaume J-C, Pigot F, Trojani M, Bonichon F. Transanal electroresection of small rectal cancer: a sole treatment?.  Dis Colon Rectum. 1996;  39 270-278
    PubMedGoogle Scholar
  • 5 Ganai S, Kanumuri P, Rao R S, Alexander A I. Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers.  Ann Surg Oncol. 2006;  13 547-556
    CrossrefPubMedGoogle Scholar
  • 6 Gonzalez Q H, Heslin M J, Shore G, Vickers S M, Urist M M, Bland K I. Results of long-term follow-up for transanal excision for rectal cancer.  Am Surg. 2003;  69 675-678
    PubMedGoogle Scholar
  • 7 Hahnloser D, Wolff B G, Larson D W, Ping J, Nivatvongs S. Immediate radial resection after local excision of rectal cancer: An oncologic compromise?.  Dis Colon Rectum. 2005;  48 429-437
    CrossrefPubMedGoogle Scholar
  • 8 Kim D G, Madoff R D. Transanal treatment of rectal cancer: ablative methods and open resection.  Semin Surg Oncol. 1998;  15 101-113
    CrossrefPubMedGoogle Scholar
  • 9 Koscinski T, Malinger S, Drews M. Local excision of rectal carcinoma not exceeding the muscularis layer.  Colorectal Dis. 2003;  5 159-163
    CrossrefPubMedGoogle Scholar
  • 10 Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi B M, Fuzesi L, Becker H. Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection.  Int J Colorectal Dis. 2003;  18 222-229
    PubMedGoogle Scholar
  • 11 Lee W, Lee D, Choi S, Chun H. Related Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer.  Surg Endosc. 2003;  17 1283-1287
    CrossrefPubMedGoogle Scholar
  • 12 Marks J H, Marchionni C, Marks G J. Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer.  Surg Endosc. 2003;  17 1114-1117
    CrossrefPubMedGoogle Scholar
  • 13 Mentges B, Buess G, Effinger G, Manncke K, Becker H D. Indications and results of local treatment of rectal cancer.  Br J Surg. 1997;  84 348-351
    CrossrefPubMedGoogle Scholar
  • 14 Middleton P F, Sutherland L M, Maddern G J. Transanal endoscopic microsurgery: a systematic review.  Dis Colon Rectum. 2005;  48 270-284
    CrossrefPubMedGoogle Scholar
  • 15 Nakagoe T, Sawai T, Tsuji T. et al . Local rectal tumor resection results: gasless, video-endoscopic transanal excision versus the conventional posterior approach.  World J Surg. 2003;  27 197-202
    PubMedGoogle Scholar
  • 16 Schafer H, Baldus S E, Gasper F, Holscher A H. Submucosal infiltration and local recurrence in pT1 low-risk rectal cancer treated by transanal endoscopic microsurgery.  Chirurg. 2005;  76 379-384
    CrossrefPubMedGoogle Scholar
  • 17 Sengupta S, Tjandra J J. Local excision of rectal cancer: what is the evidence?.  Dis Colon Rectum. 2001;  44 1345-1361
    CrossrefPubMedGoogle Scholar
  • 18 Sharma A, Hartley J, Monson J RT. Local excision of rectal tumours.  Surg Onco. 2003;  12 51-61
    PubMedGoogle Scholar
  • 19 Slisow W, Moesta K T, Schlag P M. Local excision of rectal cancer through windowed specula: long-term results.  Recent Result Cancer Res. 1998;  146 114-123
    PubMedGoogle Scholar
  • 20 Suzuki H, Furukawa K, Kan H, Tsuruta H, Matsumoto S, Akiya Y, Shinji S, Tajiri T. The role of transanal endoscopic microsurgery for rectal tumors.  J Nippon Med Sch. 2005;  72 278-284
    CrossrefPubMedGoogle Scholar
  • 21 Winde G, Nottberg H, Keller R, Schmid K W, Bünte H. Surgical cure for early rectal carcinomas (T1): transanal endoscopic microsurgery vs. anterior resection.  Dis Colon Rectum. 1996;  39 969-976
    CrossrefPubMedGoogle Scholar
  • 22 Bentrem D J, Okabe S, Wong W D, Guillem J G, Weiser M R, Temple L K, Ben-Porat L S, Minsky B D, Cohen A M, Paty P B. T1 adenocarcinoma of the rectum: transanal excision or radical surgery.  Ann Surg. 2005;  242 472-477 ,  discussion 477-479
    PubMedGoogle Scholar
  • 23 Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff R D, Rothenberg D A. Local excision of rectal cancer without adjuvant therapy a word of caution.  Ann Surg. 2000;  231 345-351
    CrossrefPubMedGoogle Scholar
  • 24 Gopaul D, Belliveau P, Vuong T, Trudel J, Vasilevsky C A, Corns R, Gordon P H. Outcome of local excision of rectal carcinoma.  Dis Colon Rectum. 2004;  47 1780-1788
    CrossrefPubMedGoogle Scholar
  • 25 Endreseth B H, Myrvold H E, Romundstad P, Hestvik U E, Bjerkeset T, Wibe A. The Norwegian Rectal Cancer Group . Transanal excision vs. major surgery for T1 rectal cancer.  Dis Colon Rectum. 2005;  48 1380-1388
    CrossrefPubMedGoogle Scholar
  • 26 Lamont J P, McCarty T M, Digan R D, Jacobson R, Tulanon P, Lichliter W E. Should locally excised T1 rectal cancer receive adjuvant chemoradiation?.  Am J Surg. 2000;  180 402-406
    CrossrefPubMedGoogle Scholar
  • 27 Madbouly K M, Remzi F H, Erkek B A, Senagore A J, Baeslach C M, Khandwala F, Fazio V W, Lavery I C. Recurrence after transanal excision of T1 rectal cancer: should we be concerned?.  Dis Colon Rectum. 2005;  48 711-719 ,  discussion 719-721
    CrossrefPubMedGoogle Scholar
  • 28 Mellgren A, Sirivong P, Rothenberg D A, Madoff R D, Garcia-Aguilar J. Is local excision adequate therapy for rectal cancer?.  Dis Colon Rectum. 2000;  43 1064-1074
    CrossrefPubMedGoogle Scholar
  • 29 Paty P B, Nash G M, Baron P. et al . Long-term results of local excision for rectal cancer.  Ann Surg. 2002;  236 522-559
    CrossrefPubMedGoogle Scholar
  • 30 Taylor R H, Hay J H, Larsson S N. Transanal local excision of selected low rectal cancer.  Am J Surg. 1998;  175 360-363
    CrossrefPubMedGoogle Scholar
  • 31 Wirsing K, Lorenzo-Rivero S, Luchtefeld M, Kim D, Monroe T, Attal H, Hoedema R. Local excision of stratified T1 rectal cancer.  Am J Surg. 2006;  191 410-412
    CrossrefPubMedGoogle Scholar
  • 32 Bailey H R, Huval W V, Max E, Smith K W, Butts D R, Zamora L F. Local excision of carcinoma of the rectum for cure.  Surgery. 1992;  111 555-561
    PubMedGoogle Scholar
  • 33 Benson R, Wong C S, Cummings B J. et al . Local excision and postoperative radiotherapy for distal rectal cancer.  Int J Radiat Oncol Biol Phys. 2001;  50 1309-1316
    CrossrefPubMedGoogle Scholar
  • 34 Bleday R, Breen E, Jessup J M, Burgess A, Sentovich S M, Steel G D. Prospective evaluation of local excision for small rectal cancers.  Dis Colon Rectum. 1997;  40 388-392
    PubMedGoogle Scholar
  • 35 Bouvet M, Milas M, Geoffrey G. et al . Predictors of recurrence after local excision and postoperative chemoradiation therapy of adenocarcinoma of the rectum.  Ann Surg Oncol. 1999;  6 26-32
    CrossrefPubMedGoogle Scholar
  • 36 Chakravarti A, Compton C C, Shellito P C. et al . Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation.  Ann Surg. 1999;  230 49-54
    CrossrefPubMedGoogle Scholar
  • 37 Coco C, Magistrelli P, Granone P, Roncolini G, Picciocchi A. Conservative surgery for early cancer of the rectum.  Dis Colon Rectum. 1992;  35 131-136
    PubMedGoogle Scholar
  • 38 Frazee R C, Patel R, Belew M, Roberts J W, Hendricks J C. Transanal excision of rectal carcinoma.  Am Surg. 1995;  61 714-717
    PubMedGoogle Scholar
  • 39 Le Voyer T E, Hoffman J P, Cooper H, Ross E, Sigurdson E, Eisenberg B. Local excision and chemoradiation for low rectal T1 and T2 cancers is an effective treatment.  Am Surg. 1999;  65 625-630
    PubMedGoogle Scholar
  • 40 Minsky B D, Enker W E, Cohen A M, Lauwers G. Local excision and postoperative radiation therapy for rectal cancer.  Am J Clin Oncol. 1994;  17 411-416
    PubMedGoogle Scholar
  • 41 Ota D M, Skibber J, Rich T A. Anderson cancer centre experience with local excision and multimodality therapy for rectal cancer.  Surg Oncol Clin North Am. 1992;  1 147-152
    PubMedGoogle Scholar
  • 42 Russell A H, Harris J, Rosenberg P J. et al . Anal sphincter conservation for patients with adenocarcinoma of the distal rectum: long-term results of radiation therapy oncology group protocol 89-02.  Int J Radiat Oncol Biol Phys. 2000;  46 313-322
    CrossrefPubMedGoogle Scholar
  • 43 Steel G D, Herndon J E, Bleday R. et al . Sphincter-sparing treatment for distal rectal adenocarcinoma.  Ann Surg Oncol. 1999;  6 433-441
    CrossrefPubMedGoogle Scholar
  • 44 Saclarides T J. Transanal endoscopic microsurgery: a single surgeon's experience.  Arch Surg. 1998;  133 595-598
    CrossrefPubMedGoogle Scholar
  • 45 Varma M G, Rogers S J, Schrock T R, Welton M L. Local excision of rectal cancer.  Arch Surg. 1999;  134 863-868
    PubMedGoogle Scholar
  • 46 Wagman R, Minsky B D, Cohen A M, Saltz L, Paty P B, Guillem J G. Conservative management of rectal cancer with local excision and postoperative adjuvant therapy.  Int J Radiat Oncol Biol Phys. 1999;  44 841-846
    CrossrefPubMedGoogle Scholar
  • 47 Willett C G. Local excision followed by postoperative radiation therapy.  Semin Radiat Oncol. 1998;  8 24-29
    PubMedGoogle Scholar
  • 48 Bedrosian I, Rodriguez-Bigas M A, Feig B. et al . Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma.  J Gastrointest Surg. 2004;  8 56-62 ,  discussion 62-63
    CrossrefPubMedGoogle Scholar
  • 49 Bonnen M, Crane C, Vauthey J N. et al . Long-term results using local excision after preoperative hemoradiation among selected T3 rectal cancer patients.  Int J Radiat Oncol Biol Phys. 2004;  60 1098-1105
    CrossrefPubMedGoogle Scholar
  • 50 Habr-Gama A, Perez R O, Nadalin W. et al . Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival.  J Gastrointest Surg. 2005;  9 90-99 ,  discussion 99-101
    CrossrefPubMedGoogle Scholar
  • 51 Hershman M J, Myint A S, Makin C A. Multi-modality approach in curative local treatment of early rectal carcinomas.  Colorectal Dis. 2003;  5 445-450
    CrossrefPubMedGoogle Scholar
  • 52 Kim C J, Yeatman T J, Coppola D. et al . Local excision of T2 and T3 rectal cancers after downstaging chemoradiation.  Ann Surg. 2001;  234 352-358 ,  discussion 358-359
    CrossrefPubMedGoogle Scholar
  • 53 Lezoche E, Guerrieri M, Paganini A M, Baldarelli M, De Sanctis A, Lezoche G. Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery.  Br J Surg. 2005;  92 1546-1552
    CrossrefPubMedGoogle Scholar
  • 54 Ruo L, Guillem J G, Minsky B D, Quan S H, Paty P B, Cohen A M. Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers.  Int J Colorectal Dis. 2002;  17 54-58
    CrossrefPubMedGoogle Scholar
  • 55 Schell S R, Zlotecki R A, Mendenhall W M, Marsh R W, Vauthey J N, Copeland 3rd  E M. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy.  J Am Coll Surg. 2002;  194 584-590 ,  discussion 590-591
    CrossrefPubMedGoogle Scholar
  • 56 Stipa F, Lucandri G, Ferri M, Casula G, Ziparo V. Local excision of rectal cancer with transanal endoscopic microsurgery (TEM).  Anticancer Res. 2004;  24 1167-1172
    PubMedGoogle Scholar
  • 57 Borschitz T, Junginger T. Local excision of T2-3 rectal carcinomas after neoadjuvant chemoradiation: premesis, experiences and results. [in preparation]
    Google Scholar
  • 58 Hermanek P, Gall F P. Early (microinvasive) colorectal carcinoma.  Int J Colorect Dis. 1986;  1 79-84
    CrossrefPubMedGoogle Scholar
  • 59 Hermanek P. A pathologist's point of view on endoscopically removed polyps of the colon and rectum.  Acta Hepatogastroenterol (Stuttg). 1978;  25 169-170
    PubMedGoogle Scholar
  • 60 Coverlizza S, Risio M, Ferrari A, Fenoglio-Preiser C M, Rossini F P. Colorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential.  Cancer. 1989;  64 1937-1947
    CrossrefPubMedGoogle Scholar
  • 61 Jass J R, Atkin W S, Cuzick J, Bussey H J, Morson B C, Northover J M, Todd I P. The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases.  Histopathology. 1986;  10 437-459
    CrossrefPubMedGoogle Scholar
  • 62 Jass J R. Lymphocytic infiltration and survival in rectal cancer.  J Clin Pathol. 1986;  39 585-589
    PubMedGoogle Scholar
  • 63 Deinlein P, Reulbach U, Stolte M, Vieth M. Risk factors for lymphatic metastasis from pT1 colorectal adenocarcinoma.  Pathologe. 2003;  24 387-393
    CrossrefPubMedGoogle Scholar
  • 64 Hermanek P, Guggenmoos-Holzmann I, Gall F P. Prognostic factors in rectal carcinoma. A contribution to the further development of tumor classification.  Dis Colon Rectum. 1989;  32 593-599
    CrossrefPubMedGoogle Scholar
  • 65 Huddy S P, Husband E M, Cook M G, Gibbs N M, Marks C G, Heald R J. Lymph node metastases in early rectal cancer.  Br J Surg. 1993;  80 1457-1458
    PubMedGoogle Scholar
  • 66 Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H. A system for a transanal endoscopic rectum operation.  Chirurg. 1984;  55 677-680
    PubMedGoogle Scholar
  • 67 Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Tanaka K, Ayabe H. Surgical technique and outcome of gasless video endoscopic transanal rectal tumour excision.  Br J Surg. 2002;  89 769-774
    CrossrefPubMedGoogle Scholar
  • 68 Swanstrom L L, Smiley P, Zelko J, Cagle L. Video endoscopic transanal-rectal tumor excision.  Am J Surg. 1997;  173 383-385
    CrossrefPubMedGoogle Scholar
  • 69 Berry A R, Souter R G, Campbell W B, Mortensen N J, Kettlewell M G. Endoscopic transanal resection of rectal tumours: a preliminary report of its use.  Br J Surg. 1990;  77 134-137
    PubMedGoogle Scholar
  • 70 Sutton C D, Marshall L J, White S A, Flint N, Berry D P, Kelly M J. Ten-year experience of endoscopic transanal resection.  Ann Surg. 2002;  235 355-362
    CrossrefPubMedGoogle Scholar
  • 71 Wetherall A P, Williams N M, Kelly M J. Endoscopic transanal resection in the management of patients with sessile rectal adenomas, anastomotic stricture and rectal cancer.  Br J Surg. 1993;  80 788-793
    PubMedGoogle Scholar
  • 72 Kanehira E, Yamashita Y, Omura K, Kinoshita T, Kawakami K, Watanabe G. Early clinical results of endorectal surgery using a newly designed rectal tube with a side window.  Surg Endosc. 2002;  16 14-17
    CrossrefPubMedGoogle Scholar
  • 73 Maeda K, Maruta M, Sato H, Hanai T, Masumori K, Matumoto M, Koide Y, Matuoka H, Katuno H. Outcomes of novel transanal operation for selected tumors in the rectum.  J Am Coll Surg. 2004;  199 353-360
    CrossrefPubMedGoogle Scholar
  • 74 Zerz A, Muller-Stich B P, Beck J, Linke G R, Tarantino I, Lange J. Endoscopic posterior mesorectal resection after transanal local excision of T1 carcinomas of the lower third of the rectum.  Dis Colon Rectum. 2006;  49 919-924
    CrossrefPubMedGoogle Scholar
  • 75 Mason A Y. Trans-sphincter surgery of the rectum.  Prog Surg. 1974;  13 66-97
    PubMedGoogle Scholar
  • 76 Wilson S E, Gordon H E. Excision of rectal lesions by the Kraske approach.  Am J Surg. 1969;  118 213-217
    CrossrefPubMedGoogle Scholar
  • 77 Graham R A, Garnsey L, Jessup L M. Local excision of rectal cancer.  Am J Surg. 1990;  160 306-312
    CrossrefPubMedGoogle Scholar
  • 78 Cook T A, Mortensen N J. Local methods of treatment of rectal cancer.  Colorectal Disease. 2000;  2 252-263
    CrossrefPubMedGoogle Scholar
  • 79 Jung M, Meier H J, Mennicken C, Barth H O, Manegold B C. Endoscopic and surgical therapy of malignant colorectal polyps.  Z Gastroenterol. 1988;  26 179-184
    PubMedGoogle Scholar
  • 80 Nakagoe T, Sawai T, Tsuji T, Hidaka S, Tanaka K, Shibasaki S, Nanashima A, Yamaguchi H, Yasutake T. Additional radical surgery after colonoscopic snare polypectomy for T1 colorectal cancer: use of the minilaparotomy approach.  Int Surg. 2004;  89 10-14
    PubMedGoogle Scholar
  • 81 Gavagan J A, Whiteford M H, Swanstrom L L. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications.  Am J Surg. 2004;  187 630-634
    CrossrefPubMedGoogle Scholar
  • 82 Baron P L, Enker W E, Zakowski M E, Urmacher C. Immediate vs. salvage resection after local treatment for early rectal cancer.  Dis Colon Rectum. 1995;  38 177-181
    PubMedGoogle Scholar
  • 83 Morson B C. Evolution of cancer of the colon and rectum.  Cancer. 1974;  34 845-849
    PubMedGoogle Scholar
  • 84 Nagtegaal I D, Marijnen C A, Kranenbarg E K, van de Velde C J, van Krieken J H. Pathology Review Committee, Cooperative Clinical Investigators . Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit.  Am J Surg Pathol. 2002;  26 350-357
    CrossrefPubMedGoogle Scholar
  • 85 Wibe A, Syse A, Andersen E, Tretli S, Myrvold H E, Soreide O. Norwegian Rectal Cancer Group . Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection.  Dis Colon Rectum. 2004;  47 48-58
    CrossrefPubMedGoogle Scholar
  • 86 Stipa F, Burza A, Lucandri G, Ferri M, Pigazzi A, Ziparo V, Casula G, Stipa S. Outcomes for early rectal cancer managed with transanal endoscopic microsurgery: a 5-year follow-up study.  Surg Endosc. 2006;  20 541-545
    CrossrefPubMedGoogle Scholar
  • 87 Hermanek P, Junginger T. The circumferential resection margin in rectal carcinoma surgery.  Tech Coloproctol. 2005;  9 193-199 ,  discussion 199-200
    CrossrefPubMedGoogle Scholar
  • 88 Marr R, Birbeck K, Garvican J. et al . The modern abdominoperineal excision: the next challenge after total mesorectal excision.  Ann Surg. 2005;  242 74-82
    CrossrefPubMedGoogle Scholar
  • 89 Floyd N D, Saclarides T J. Transanal endoscopic microsurgical resection of pT1 rectal tumors.  Dis Colon Rectum. 2006;  49 164-168
    CrossrefPubMedGoogle Scholar
  • 90 Wirsing K, Lorenzo-Rivero S, Luchtefeld M. et al . Local excision of stratified T1 rectal cancer.  Am J Surg. 2006;  191 410-412
    CrossrefPubMedGoogle Scholar
  • 91 Parr C, Jiang W G. Quantitative analysis of lymphangiogenic markers in human colorectal cancer.  Int J Oncol. 2003;  23 533-539
    PubMedGoogle Scholar
  • 92 Borschitz T, Heintz A, Junginger T. Transanal endoscopic microsurgical excision of pT2 rectal cancer: Results and possible indications. Dis Colon Rectum 2006 [in press]
    Google Scholar
  • 93 Borschitz T, Junginger T. The value of immediate versus salvage reoperation after local excision of early “high risk” and T2 rectal carcinomas. [under review]
    Google Scholar
  • 94 Nakagoe T, Ishikawa H, Sawai T, Tsuji T. Long-term outcomes of radical surgery after gasless video endoscopic transanal excision of T1/T2 rectal cancers.  Eur J Surg Oncol. 2004;  30 638-642
    CrossrefPubMedGoogle Scholar
  • 95 Friel C M, Cromwell J W, Marra C, Madoff R D, Rothenberger D A, Garcia-Aguilar J. Salvage radical surgery after failed local excision for early rectal cancer.  Dis Colon Rectum. 2002;  45 875-879
    CrossrefPubMedGoogle Scholar
  • 96 Weiser M R, Landmann R G, Wong W D, Shia J, Guillem J G, Temple L K, Minsky B D, Cohen A M, Paty P B. Surgical salvage of recurrent rectal cancer after transanal excision.  Dis Colon Rectum. 2005;  48 1169-1175
    CrossrefPubMedGoogle Scholar
  • 97 Borschitz T, Junginger T, Hermanek P. Lymph node status after neoadjuvant chemoradiotherapy of rectal cancer in dependence of the yT finding. [in preparation]
    Google Scholar
  • 98 Hartley A, Ho K F, McConkey C, Geh J I. Pathological complete response following pre-operative chemoradiotherapy in rectal cancer: analysis of phase II/III trials.  Br J Radiol. 2005;  78 934-938
    PubMedGoogle Scholar

Prof. Dr. med. T. Junginger

Klinik und Poliklinik für Allgemein- und Abdominalchirurgie · Johannes-Gutenberg-Universität

Langenbeckstr. 1

55131 Mainz

Deutschland

Phone: +49/61 31/17 72 91

Fax: +49/61 31/17 66 30

Email: borschitz@ach.klinik.uni-mainz.de

      >